Into and out of the cochlea: A re-implantation saga.

Introduction: In patients with normal inner ear architecture at imaging and who received a prior cochlear implant (CI) without difficulty, the expectation is that replacing a failed CI should be straightforward. Here, we present a patient in whom an unusual complication (to our knowledge, not reported) was encountered. Methods: Review of audiological and medical and surgical records and imaging data. Results: Re-implantation went well except no electrically elicited compound action potential could be elicited via any electrode. The replacement CI did not provide any auditory perception. CT showed the electrode array to enter the cochlea with three electrodes, but all other electrodes extended toward the Eustachian tube. Subsequent re-implantation into the scala vestibuli yielded excellent performance with the CI. Conclusion: Mechanical forces, such as from a CI array, can erode the hardest bone over time. This possibility should be a consideration in patients who are undergoing CI device replacement.

Pain-only complaint about cochlear implant device: A five-patient pediatric experience.

OBJECTIVES: To present the case histories and management of five pediatric patients who experienced pain at the receiver-stimulator site, but no other indication that the device was failing. Patients were from a sole-surgeon pediatric practice (600 + implant surgeries before June 2013; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). METHODS: The University Institutional Review Board-approved review of sole-surgeon pediatric case series. RESULTS: The onset of pain ranged from 2 to 16 years post implantation. Pain, not amenable to conventional medical therapy, was present regardless of whether or not the external appliance was 'on', or even being worn on the head. Four of the five patients were bilaterally implanted, but pain was only at one receiver-stimulator package. Clinical management ultimately included revision surgery in all five cases, with immediate resolution of the pain in four. For those four, the replacement cochlear implant (CI) performed well; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant. At analysis by the company, two of five explanted devices exhibited problems: loss of hermeticity; insulation failure. DISCUSSION: Though infrequently reported, pain-only complaint by a CI user is a challenging dilemma. CONCLUSION: Pain may be the sole clinical manifestation of cochlear implant device failure. We offer a flowchart for the care of CI patients with pain, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem.